• Active tuberculosis (with other agents).
• Elimination of meningococcal carriers.

Unlabeled Uses:

• Prevention of disease caused by Haemophilus influenzae type B in close contacts.
• Synergy with other antimicrobial agents for S. aureus infections.

Contraindicated in:

• Hypersensitivity
• Concurrent use of atazanavir, darunavir, fosamprenavir, lurasidone, praziquantel, or tipranavir.

Use Cautiously in:

• History of liver disease (↑ risk of hepatotoxicity)
• Chronic liver disease, poor nutritional status, or prolonged use of antibacterial drugs or anticoagulants (↑ risk of vitamin K deficiency and subsequent coagulation disorders)
• Diabetes
• Concurrent use of other hepatotoxic agents
• OB: Safety not established in pregnancy
• Lactation: Safety not established in breastfeeding.

Derm: ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS, DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), pruritus, rash, STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS.

EENT: red discoloration of tears.

GI: abdominal pain, diarrhea, flatulence, heartburn, nausea, vomiting, HEPATOTOXICITY, red discoloration of saliva and teeth.

GU: red discoloration of urine.

Hemat: bleeding, hemolytic anemia, thrombocytopenia, THROMBOTIC MICROANGIOPATHY (INCLUDING THROMBOTIC THROMBOCYTOPENIC PURPURA AND HEMOLYTIC UREMIA SYNDROME).

MS: arthralgia, muscle weakness, myalgia.

Neuro: ataxia, confusion, drowsiness, fatigue, headache, weakness.

Resp: INTERSTITIAL LUNG DISEASE.
Misc: flu-like syndrome, (INCLUDING ANGIOEDEMA)HYPERSENSITIVITY REACTIONS .

Drug-Drug:

• Significantly ↓ levels and effectiveness of atazanavir, darunavir, fosamprenavir, lurasidone, praziquantel, and tipranavir; concurrent use contraindicated.
• Significantly ↓ levels and effectiveness of efavirenz, quinine, sofosbuvir, ticagrelor, and zidovudine; avoid concomitant use.
• Significantly ↓ levels and effectiveness of hormonal contraceptives; use nonhormonal birth control during rifampin therapy.
• May ↓ levels and effectiveness of numerous drugs, including chloramphenicol, clarithromycin, cyclosporine, diazepam, diltiazem, disopyramide, doxycycline, fluconazole, glipizide, glyburide, haloperidol, ketoconazole, levothyroxine, losartan, lovastatin, metoprolol, mexiletine, morphine, moxifloxacin, nifedipine, nortriptyline, ondansetron, oxycodone, phenytoin, prednisolone, propafenone, propranolol, quinidine, simvastatin, tamoxifen, theophylline, toremifene, verapamil, and zolpidem.
• May ↑ levels of active metabolite of clopidogrel, which may ↑ risk of bleeding; avoid concomitant use.
• May ↓ levels and effectiveness of warfarin; monitor INR regularly during concurrent therapy.
• May significantly ↓ levels and effectiveness of itraconazole; avoid use 2 wk before and during itraconazole therapy.
• May significantly ↓ levels and effectiveness of irinotecan; avoid use 2 wk before and during irinotecan therapy.
• May ↓ levels and effectiveness of digoxin; closely monitor serum digoxin concentrations and ↑ digoxin dose by 20–40%, if needed.
• May significantly ↓ levels and effectiveness of tacrolimus; monitor tacrolimus whole blood concentrations regularly and ↑ tacrolimus dose as necessary.
• May ↓ levels and effectiveness of methadone, which may ↑ risk of withdrawal symptoms.
• Absorption may be ↓ by antacids; administer rifampin 1 hr prior to antacids.
• Probenecid and trimethoprim/sulfamethoxazole may ↑ levels and risk of toxicity.
• Concurrent use with atovaquone may ↓ atovaquone levels and effectiveness and ↑ levels and risk of toxicity of rifampin; avoid concomitant use.
• May ↓ levels and effectiveness of dapsone; may also ↑ levels and toxicity of the active metabolite of dapsone, which could ↑ the risk of methemoglobinemia.

(Generic available)

• Capsules: 150 mg; 300 mg;
• Powder for injection: 600 mg/vial;

Tuberculosis

• PO, IV (Adults): 600 mg/day or 10 mg/kg/day (up to 600 mg/day) single dose; may also be given twice weekly.
• PO, IV (Children and Infants): 10–20 mg/kg/day single dose or divided every 12 hr (not to exceed 600 mg/day); may also be given twice weekly.

Asymptomatic Carriers of Meningococcus

• PO, IV (Adults): 600 mg every 12 hr for 2 days.
• PO, IV (Children 1 mo): 10 mg/kg every 12 hr for 2 days (max: 600 mg/dose).
• PO (Infants <1 mo): 5 mg/kg every 12 hr for 2 days.

H. influenzae Prophylaxis

• PO (Adults): 600 mg/day for 4 days.
• PO (Children): 20 mg/kg/day for 4 days (max: 600 mg/dose).
• PO (Neonates): 10 mg/kg/day for 4 days.

Synergy for S. aureus Infections

• PO (Adults): 300–600 mg twice daily.
• PO (Children and Neonates): 5–20 mg/kg/day divided every 12 hr (max: 600 mg/dose).

Rifadin, Rimactane

• Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms.

• Bactericidal action against susceptible organisms.

Spectrum:

• Broad spectrum notable for activity against:
  • Mycobacterium spp.,
  • Staphylococcus aureus,
  • H. influenzae,
  • Legionella pneumophila,
  • Neisseria meningitidis.

Therapeutic Classification: antituberculars

Pharmacologic Classification: rifamycins

Absorption: Well absorbed following oral administration.

Distribution: Widely distributed; enters CSF.

Protein Binding: 80%.

Metabolism/Excretion: Mostly metabolized by the liver; 60% eliminated in feces via biliary elimination.

Half-life: 3 hr.

Rofact

(plasma concentrations)

• Advise patient to take medication once daily (unless biweekly regimens are used), as directed, and not to skip doses or double up on missed doses. Emphasize the importance of continuing therapy even after symptoms have subsided. Length of therapy for tuberculosis depends on regimen being used and underlying disease states. Patients on short-term prophylactic therapy should also be advised of the importance of compliance with therapy.
• Advise patient to notify health care professional promptly if signs and symptoms of hepatitis (yellow eyes and skin, nausea, vomiting, anorexia, unusual tiredness, weakness) or of thrombocytopenia (unusual bleeding or bruising) occur.
• Caution patient to avoid the use of alcohol during this therapy, because this may increase the risk of hepatotoxicity.
• Instruct patient to report the occurrence of flu-like symptoms (fever, chills, myalgia, headache) promptly.
• Rifampin may occasionally cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
• Inform patient that saliva, sputum, teeth, sweat, tears, urine, and feces may become red-orange to red-brown and that soft contact lenses may become permanently discolored.
• Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy.
• Emphasize the importance of regular follow-up exams to monitor progress and to check for side effects.

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